SINGAPORE: When 86-year-old Paul Wong was diagnosed with terminal stomach cancer in January, he chose to spend the rest of his days in the comfort of his home.
A year ago, his wife passed away from colorectal cancer at home with the support of Assisi Hospice’s hospice home care service.
“I saw the care she received and I hope would be able to receive that too,” he told CNA.
“I’ve stayed here for over 40 years. I find the place quiet, and the neighbours are friendly. I hope to be comfortable and manage my pain.”
His daughter and grandchildren also live nearby and visit him for meals and activities.
Mr Wong is among a growing number in Singapore opting for palliative support at home. They have also gotten a boost from the government, which is looking to increase the availability of such end-of-life care.
To help more people spend their final days the way they wish to, the Ministry of Health (MOH) has put in place a National Strategy for Palliative Care.
Since its launch in 2023, home palliative care capacity has grown by 25 per cent, from 2,400 to 3,000 places. It is set to increase to 3,600 places by the end of this year.
An equipment rental scheme that was put in place, which provides patients with subsidised essentials like hospital beds, has benefited more than 1,000 Singaporeans so far.
Care providers said it is not just about infrastructure, but also having competent palliative care staff – and there is a shortage.
In fact, demand for such care is rising faster than manpower, with providers saying they need more trained staff to keep up.
HCA Hospice Care, the nation’s largest home hospice provider, said hiring is an ongoing issue.
"One of the things I struggle with is to find the right people with the right heart to do this work,” said its medical director Dr Chong Poh Heng.
“It's not a terribly glamorous (job) to work in the home, in different settings, some of which are, in my opinion, not quite habitable,” Dr Chong added.
“But the patient is comfortable there, so within those limitations (we must) find the means to deliver the same quality of care to those patients and their families."
The hospice looks after about 1,400 home patients and will soon increase capacity to take in more.
Among its ways to manage manpower issues is enlisting the help of the patients’ caregivers.
"We teach (caregivers) some of the knowledge aspects, including hands on (care), hygiene care, serving of medication, sometimes giving injections too,” said Dr Chong.
Family members also learn to prepare special food and manage appliances like oxygen concentrators or suction machines, he added.
One challenge in hiring is finding personnel with adequate skills and qualifications, as roles in the sector can take years to learn.
Assisi Hospice said its staff nurses are trained for up to three years before they are fully competent and can deliver care effectively.
It is the largest inpatient facility in Singapore, and is leveraging home care to meet growing demand. Its home caseload has grown nearly five-fold over the last decade to about 700 today. The figure is projected to reach 850 by late 2026.
Aside from medical know-how, staff also need training to understand how to manage the mental and psychosocial needs of the patients and their families.
A palliative care nurse helping an elderly patient.
“Palliative care patients (are) very ill, with many comorbidities, different organs may not be functioning. They have been through a lot,” said the hospice’s CEO Choo Shiu Ling.
“Their journey in the healthcare system would have been very long. They have a high complexity of needs. Their caregivers could be emotionally and financially exhausted,” she added.
“It is the nurses and the special skills of a palliative care team that can possibly address all these very complex (issues).”
She said the hospice’s priority is to train its healthcare staff well and continue to grow its home care team.
“Because we discover (that) when nurses are confident and competent, it aids retaining so they stay with us, and we actually have a very low or almost no attrition for our home care team,” noted Ms Choo.
Assisi Hospice currently has 48 staff tending to end-of-life patients at home, and plans to grow the team to 60 by the end of next year.
There are around nine providers in Singapore that specialise in home palliative care.
The sector needs at least 20 to 30 per cent more home hospice staff as the population ages, warned the Singapore Hospice Council.
Board member Mervyn Koh suggested adequate remuneration and recognition could attract more to the industry.
With funding another key concern as home hospice is fully subsidised, he said he also expects such care to be chargeable in future.
“Chargeable doesn't mean expensive. If it is MediSave deductible, that may be the way to go in future to keep healthcare costs sustainable,” said Dr Koh, who is also a senior consultant of palliative medicine at Tan Tock Seng Hospital.
“This will enable families to still (fulfil) the wishes of patients passing on at home without having to fork out cash by themselves.”
He pointed out that most home hospice care providers are charity organisations, and it may be challenging to keep up free home care due to rising costs.
"Policy makers can consider potentially opening up, say, MediShield Life to support home hospice care,” Dr Chong said.
“Currently, it can be used in the hospital, in inpatient hospice facilities, but it's not quite possible to use MediShield or insurance to pay for home care."
CNA understands that council members regularly engage with MOH on the future of the sector, including financing.
Continue reading...
A year ago, his wife passed away from colorectal cancer at home with the support of Assisi Hospice’s hospice home care service.
“I saw the care she received and I hope would be able to receive that too,” he told CNA.
“I’ve stayed here for over 40 years. I find the place quiet, and the neighbours are friendly. I hope to be comfortable and manage my pain.”
His daughter and grandchildren also live nearby and visit him for meals and activities.
Mr Wong is among a growing number in Singapore opting for palliative support at home. They have also gotten a boost from the government, which is looking to increase the availability of such end-of-life care.
To help more people spend their final days the way they wish to, the Ministry of Health (MOH) has put in place a National Strategy for Palliative Care.
Since its launch in 2023, home palliative care capacity has grown by 25 per cent, from 2,400 to 3,000 places. It is set to increase to 3,600 places by the end of this year.
An equipment rental scheme that was put in place, which provides patients with subsidised essentials like hospital beds, has benefited more than 1,000 Singaporeans so far.
Care providers said it is not just about infrastructure, but also having competent palliative care staff – and there is a shortage.
HIRING STRUGGLES
In fact, demand for such care is rising faster than manpower, with providers saying they need more trained staff to keep up.
HCA Hospice Care, the nation’s largest home hospice provider, said hiring is an ongoing issue.
"One of the things I struggle with is to find the right people with the right heart to do this work,” said its medical director Dr Chong Poh Heng.
“It's not a terribly glamorous (job) to work in the home, in different settings, some of which are, in my opinion, not quite habitable,” Dr Chong added.
“But the patient is comfortable there, so within those limitations (we must) find the means to deliver the same quality of care to those patients and their families."
The hospice looks after about 1,400 home patients and will soon increase capacity to take in more.
Among its ways to manage manpower issues is enlisting the help of the patients’ caregivers.
"We teach (caregivers) some of the knowledge aspects, including hands on (care), hygiene care, serving of medication, sometimes giving injections too,” said Dr Chong.
Family members also learn to prepare special food and manage appliances like oxygen concentrators or suction machines, he added.
Related:
TRAINING TAKES YEARS
One challenge in hiring is finding personnel with adequate skills and qualifications, as roles in the sector can take years to learn.
Assisi Hospice said its staff nurses are trained for up to three years before they are fully competent and can deliver care effectively.
It is the largest inpatient facility in Singapore, and is leveraging home care to meet growing demand. Its home caseload has grown nearly five-fold over the last decade to about 700 today. The figure is projected to reach 850 by late 2026.
Aside from medical know-how, staff also need training to understand how to manage the mental and psychosocial needs of the patients and their families.
A palliative care nurse helping an elderly patient.
“Palliative care patients (are) very ill, with many comorbidities, different organs may not be functioning. They have been through a lot,” said the hospice’s CEO Choo Shiu Ling.
“Their journey in the healthcare system would have been very long. They have a high complexity of needs. Their caregivers could be emotionally and financially exhausted,” she added.
“It is the nurses and the special skills of a palliative care team that can possibly address all these very complex (issues).”
She said the hospice’s priority is to train its healthcare staff well and continue to grow its home care team.
“Because we discover (that) when nurses are confident and competent, it aids retaining so they stay with us, and we actually have a very low or almost no attrition for our home care team,” noted Ms Choo.
Assisi Hospice currently has 48 staff tending to end-of-life patients at home, and plans to grow the team to 60 by the end of next year.
Related:
RISING COSTS
There are around nine providers in Singapore that specialise in home palliative care.
The sector needs at least 20 to 30 per cent more home hospice staff as the population ages, warned the Singapore Hospice Council.
Board member Mervyn Koh suggested adequate remuneration and recognition could attract more to the industry.
With funding another key concern as home hospice is fully subsidised, he said he also expects such care to be chargeable in future.
“Chargeable doesn't mean expensive. If it is MediSave deductible, that may be the way to go in future to keep healthcare costs sustainable,” said Dr Koh, who is also a senior consultant of palliative medicine at Tan Tock Seng Hospital.
“This will enable families to still (fulfil) the wishes of patients passing on at home without having to fork out cash by themselves.”
He pointed out that most home hospice care providers are charity organisations, and it may be challenging to keep up free home care due to rising costs.
"Policy makers can consider potentially opening up, say, MediShield Life to support home hospice care,” Dr Chong said.
“Currently, it can be used in the hospital, in inpatient hospice facilities, but it's not quite possible to use MediShield or insurance to pay for home care."
CNA understands that council members regularly engage with MOH on the future of the sector, including financing.
Continue reading...